Who’s on Call?

03.16.2016

By Joan E. Collier

An investigative report by News Channel 4 in New York City reveals that the state Workers' Compensation Board is sending claimants to doctors who don’t accept workers’ compensation patients because of outdated records.

One claimant, a supermarket worker who experienced bleeding in his eye after falling off a ladder, says that after four years, he still cannot find an eye surgeon to perform the procedure needed to scrape blood off of his retina.

The news media’s I-Team says that it called 64 eye specialists listed as serving Brooklyn on the state's Workers' Compensation Health Provider Search; two-thirds of the doctors’ offices reported that they don’t participate in the program.

Can we dismiss this and similar scenarios with a shrug and a “stuff happens,” or is it more problematic and systemic than that?

Back in the old days, when offices were considered state-of-the-art if they were equipped with electric typewriters, we could excuse a delay in information transmittal and lost paperwork with “stuff happens.” But now, in our data-centric and connected world, what’s the excuse for not keeping records current? A Board spokesperson says the doctor list is updated weekly, but had no explanation for why so many specialists are incorrectly listed as participants.

Of course, record keeping is just the surface problem. The real problem is that there are not enough authorized workers’ compensation doctors in the system. Which leads us to what some are saying is the over-arching problem—meddling insurance companies and nit-picky regulators.

Why am I not surprised?

Insurance companies are blamed for meddling in the decisions of the health care professionals, and officials are blamed for making the process to become an authorized workers’ compensation doctor so onerous that physicians are fleeing the system. It’s probably a little bit of both, with plaintiff lawyers in the mix there, too, just to liven things up.

Nobody says the system is perfect, but I think that maintaining a valid list of providers is a pretty low bar to leap.

The New York Workers' Compensation Board advises workers who are having trouble finding an authorized doctor to call 800-781-2362. I called. All representatives were busy, but they promised to get back to me.

(Read more Work Comp Nation blogs here.)

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Comments

Networks like to promote that they have an extensive list of providers…validity of the list?  Not so much concern.  This problem not limited to Workers’ Comp.  In the Medicare world, insurance companies who offer “Medicare Advantage” plans are now (eff Jan 2016) required to verify their Provider Directories by checking with the doctors to be sure their listings are correct.

Ann Crutchfield

2016 03 23

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